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Manual Muscle Testing

Manual Muscle Testing (MMT) is a procedure to evaluate muscular strength and weakness due to various conditions, providing essential data for therapeutic planning. It involves assessing muscular strength, endurance, and power through different contraction types and is crucial for rehabilitation in patients with neurological issues or injuries. MMT uses a grading system to quantify muscle strength and has specific principles for proper execution, though it has limitations regarding functional relevance and variability.

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21 views

Manual Muscle Testing

Manual Muscle Testing (MMT) is a procedure to evaluate muscular strength and weakness due to various conditions, providing essential data for therapeutic planning. It involves assessing muscular strength, endurance, and power through different contraction types and is crucial for rehabilitation in patients with neurological issues or injuries. MMT uses a grading system to quantify muscle strength and has specific principles for proper execution, though it has limitations regarding functional relevance and variability.

Uploaded by

stishaaaa
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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MANUAL MUSCLE

TESTING (MMT)

Ms. Cyanna Dsouza


What is MMT?

• Manual
Muscle Testing is used to determine the extent and degree of muscular
weakness resulting from disease, injury or disuse.

• The
records obtained from these tests provide a base for planning therapeutic
procedures and periodic re-testing.

• Muscle
testing is an important tool for all members of health team dealing with
physical residuals of disability.
BASIC CONCEPTS
• MuscularStrength: the maximal amount of tension or force that a muscle or
muscle group can exert in a maximal effort.

• Muscular Endurance: the ability of a muscle or muscle group to perform repeated


contractions against resistance or maintain an isometric contraction for a period of
time

• Muscular power: the ability of a muscle or muscle group to exert a maximal force
in as short a time as possible. Also de ned as amount of work performed per unit
time.
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Types of Muscle Work

1. Isometric Contraction: Tension is developed in the muscle but no movement


occurs; the origin and insertion of the muscle do not change their positions and
hence the muscle length does not change
2. Isotonic Contraction: The muscle develops constant tension against a load or
resistance. There are two types:
A. Concentric Contraction: Tension is developed in the muscle and the origin and
insertion of the muscle move close together; hence shortening occurs
B. Eccentric Contraction: Tension is developed in the muscle and the origin and
insertion of the muscle move further apart; hence lengthening occurs
Range of Muscle Work

The full range in which a muscle changes from a position of full stretch and
contracting to a position of maximal shortening.
The full range is divided into three parts:
• Outer
Range: From a position where the muscle is fully stretched to a position
halfway through the full range of motion
• Inner
Range: From a position halfway through the full range of motion to a position
where the muscle is fully shortened
• Middle
Range: The portion of the full range between the mid-point of the outer
range and the mid-point of the inner range
Group of Muscle Action

• Primemover or Agonist: A muscle or muscle group that makes the major


contribution to movement at the joint

• Antagonist: A muscle or muscle group that has an opposite action to the prime
movers

• Synergist: A muscle that contracts and works along with the agonist to produce the
desired movement.
DEFINITION
OF MMT
De nition of MMT

• Manual Muscle Testing is a procedure for the


evaluation of strength of individuals muscles or muscle
groups, based upon the effective performance of a
movement in relation to the forces of gravity or manual
resistance through the available range of motion.

• MMT is the most vital part of motor assessment


performed in Medical examination
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• MMTis used to evaluate weakness and can be effective in differentiating true
weakness from imbalance or poor endurance.
• It
may also be referred to as motor testing, muscle strength grading, manual muscle
testing.
• Musclestrength can be assessed by a number of methods-manually, functionally,
or mechanically.
• Strength depends on the combination of morphological and neural factors including
muscle cross-sectional area and architecture, musculotendinous stiffness, motor
unit recruitment, rate coding, motor unit synchronization, and neuromuscular
inhibition.
INDICATIONS & USES
OF MMT
The function of muscle strength testing is to evaluate the complaint of weakness,
often when there is a suspected neurologic disease or muscle imbalance/weakness
such as:

• patientswith stroke, brain injury, spinal cord injury, neuropathy, amyotrophic lateral
sclerosis, and a host of other neurologic problems
• rehabilitation after sporting injuries eg ACL repair
• after fractures and joint replacements eg TKR
• gait and balance problems in the older adult
• falls risk assessment
GRADING SYSTEMS
IN MMT
Grade 0 : No muscle contraction

Grade 1 : Flicker of Contraction

Grade 2 : Full Range of Motion eliminating gravity

Grade 3 : Full Range of Motion against gravity

Grade 4 : Full Range of Motion against minimal resistance

Grade 5 : Full Range of Motion against maximum resistance


Oxford Scale - Medical Research Council

• The MRC Scale for Muscle Strength is a commonly used scale for assessing muscle
strength from Grade 5 (normal) to Grade 0 (no visible contraction).
• It was originally described by the Medical Research Council in 1943
• The MRC sum score was rst described by Kleyweg et al (1988) for use in the Dutch
Guillain-Barré trial.
• This score was de ned as the sum of MRC scores from six muscles in the upper and
lower limbs on both sides so that the score ranged from 60 (normal) to 0 (quadriplegic).
• The Criteria requires that each of the six muscle groups listed in the table are
examined bilaterally, each with a score from 0 to 5 according to the scale in the right
hand column.
•
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Kendall Scale

• The MRC Scale for Muscle Strength is a commonly used scale for assessing
muscle strength from Grade 5 (normal) to Grade 0 (no visible contraction).

• Additional + or - grades
•
PRINCIPLES
OF MMT
1. Position
2. Stabilisation
3. Demonstration
4. Application of Grades
5. Application of Resistance
6. Checking normal strength
7. Objectivity
8. Documentation
Position

PATIENT POSITION:

• Patient
is placed in a position that eliminates gravity or is against gravity
depending on the muscle or muscle group.
• Do not change patient position repeatedly.
• The patient should be as comfortable as possible and free of pain.
• The
patient’s position must permit adequate stabilisation of the body parts
being tested by virtue of body weight or with the help of the examiner.
Position

JOINT POSITION:

• Joint position is also changed depending upon the muscle performance


• The proximal joint is stabilised and distal joint is moved.
• Place joint in antigravity position - Grade 3 onwards
• Place joint in gravity eliminated position - Grade 2
Stabilization

•The patient is stabilised by virtue of body weight in antigravity


position, unless help required by the therapist
•Proximal hand - At origin of the muscle or proximal joint
•Distal Hand - offers assistance or resistance to the distal joint
•
Demonstration

•Therapist demonstrates the movement


•Or teach the movement to the patient on the sound limb

•
Application of Grades

• Therapistshould have thorough knowledge of the Grades of MMT


• Apply assistance or resistance wherever necessary
•
Application of Resistance

•Resistance is typically applied to the distal end of the segment


•Resistance is applied opposite to the desired motion
•Stabilisation is necessary to avoid unwanted or substitute motions
•Resistance is applied slowly and gradually
•Intensity varies between therapists and patients
•
BREAK TEST / MAKE TEST

• Resistance applied at the end of the tested range is called Break test
• Resistance applied throughout the tested range is called Make test
• The isometric hold (break test) shows the muscle to have a higher grade than the
make test
• Indications of Break test - when movement is painful/contrindicated; assesses
quality of strength and not quantity
•
Checking Normal Strength

•The therapist must check the strength of the muscle or muscle group
on the normal side rst
•
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Documentation

•The examiner must document the ndings


•This helps for the next step of treatment assessment and applications
•Documentation also helps in assessing patient’s response to
treatment and check prognosis
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LIMITATIONS
OF MMT
• Poor functional relevance
• Non-linearity
i.e. the difference between grades 3 and 4 is not necessarily the same
as the difference between grades 4 and 5
• A patient's variability over time i.e. alternating between grades due to fatigue
• Intra-rater reliability
• Only assesses muscles when contracting concentrically
THANK YOU

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